Medicare Part D
Part D in Kaneohe: $2,100 Cap and No More Donut Hole
KANEOHE, Hawaii — If you take prescription drugs and have Medicare, the Part D out-of-pocket cap rises again for 2027. There's a hard yearly limit on what you pay out of pocket for covered drugs — and the old "donut hole" is gone for good.
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Speak to a Licensed Insurance Agent
Click to call 855-729-3240Key takeaways
- The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027, and the old "donut hole" coverage gap no longer exists.
- Part D has three phases: a deductible (no more than $615 in 2026 and $700 in 2027 for any plan), an initial coverage phase with copays, and a catastrophic phase where covered drugs cost nothing for the rest of the year.
- Only what you pay for covered drugs, like your deductible, copays, and coinsurance, counts toward the annual cap, while premiums, non-covered drugs, and over-the-counter medicines do not.
- Every Part D plan must offer the Medicare Prescription Payment Plan, a free, optional way to spread drug costs into monthly bills instead of paying it all at once, though it does not lower the total amount owed.
Here's a plain-English look at how Part D works for 2027, what the new numbers mean, and where Kaneohe residents can turn for help.
The three phases of Part D for 2027
Part D used to have four phases, including the confusing coverage gap known as the donut hole. As of 2025, that gap is eliminated. Your drug coverage now moves through just three phases:
1. The deductible phase. You pay the full negotiated price for your drugs until you meet your plan's deductible. In 2026, no Part D plan can charge a deductible higher than $615. Some plans set it lower, and some drugs may be covered before you hit it. 2. The initial coverage phase. After the deductible, you pay a copay or coinsurance for each prescription, and your plan pays the rest. You stay in this phase until your out-of-pocket spending reaches the annual cap. 3. The catastrophic phase. Once your out-of-pocket costs on covered drugs hit $2,100 for the year, you pay $0 for the rest of 2026 on covered Part D drugs.
That annual ceiling is the headline change. Before 2024, there was no true cap. Now, no matter how expensive your covered medications are, your spending on them stops once you reach the cap — $2,100 in 2026 and $2,400 in 2027.
What counts toward the annual cap
Only your out-of-pocket spending on covered Part D drugs counts toward the cap. That includes your deductible and any copays or coinsurance you pay at the pharmacy.
What does not count: your monthly Part D premium, drugs your plan doesn't cover, and over-the-counter medications. If a drug isn't on your plan's formulary (its list of covered drugs), paying for it won't move you closer to the cap.
This is why checking a plan's formulary each year matters. Formularies can change from one year to the next.
The Medicare Prescription Payment Plan
New in 2025 and continuing for 2027, every Part D plan must offer the Medicare Prescription Payment Plan. It lets you spread your out-of-pocket drug costs across the year in monthly bills, instead of paying a large amount at the pharmacy counter.
It doesn't lower what you owe — the total is the same — but it can make a big bill in January easier to handle if you take a high-cost medication. Enrollment is optional and free. You can sign up through your Part D or Medicare Advantage drug plan.
What this looks like in Kaneohe
Kaneohe is in Honolulu County, where Medicare beneficiaries can get Part D coverage in one of two ways: through a stand-alone Part D prescription drug plan (added to Original Medicare) or through a Medicare Advantage plan that includes drug coverage.
The rules above — the maximum deductible, the annual out-of-pocket cap, and the three phases — apply the same way whether you live in Kaneohe, Kailua, or Honolulu. The number and mix of available plans is set at the county level. For 2027, Honolulu County has 26 Medicare Advantage plans from 7 carriers, with 5 new plans, 4 not returning, and 3 renamed; Centene (WellCare) is not offering plans in the county next year. You can compare what's offered in Honolulu County at Medicare.gov/plan-compare.
Higher-income enrollees: watch for IRMAA
If your income is above certain limits, you may pay an Income-Related Monthly Adjustment Amount (IRMAA) on top of your regular Part D premium. For 2026, IRMAA generally begins for single filers with income above $109,000 (based on your tax return from two years earlier).
Social Security notifies you by mail if IRMAA applies. If your income has dropped due to a life event like retirement or the loss of a spouse, you can ask Social Security to reconsider.
Key dates to remember
- October 15 – December 7, 2026: Medicare Annual Enrollment Period. This is when you can join, switch, or drop a Part D or Medicare Advantage plan for 2027.
- January 1 – March 31: Medicare Advantage Open Enrollment Period. If you're already in a Medicare Advantage plan, you can switch to another one or return to Original Medicare (and add a Part D plan).
Even if you're happy with your current coverage, it's smart to review your plan each fall. Formularies, pharmacy networks, and costs can change.
By the numbers
Medicare Part B premium, 2006–2026
The standard monthly Part B premium has climbed from $88.50 in 2006 to $202.90 in 2026. Hover any point for that year’s premium.
Source: CMS. Standard premium shown; in some hold-harmless years many existing enrollees paid less. Confirm at Medicare.gov.
By the numbers
How people get Medicare in Honolulu County
(MA penetration in Honolulu County)
MA penetration from CMS enrollment data; Medigap share is an estimate. U.S. average is about 54% Medicare Advantage. These are area-level figures, not plan-specific.
Prescription coverage
How Medicare Part D works for 2027
The old coverage gap (“donut hole”) is eliminated as of 2025 (three phases now). The hard yearly cap on what you pay out of pocket for covered drugs is $2,100 in 2026 and $2,400 in 2027, and you can spread those costs across the year with the Medicare Prescription Payment Plan.
Try it
How the 2026 Part D drug cap works
Slide to your estimated yearly prescription costs and see how the new $2,100 out-of-pocket cap protects you. This illustrates the standard Part D benefit; your plan may structure costs differently.
Once your out-of-pocket spending on covered drugs reaches $2,100, you pay nothing more for the rest of 2026. Confirm details at Medicare.gov.
Explore
When can you enroll? An interactive year
Enrollment windows are federal and the same nationwide. Confirm your personal dates at Medicare.gov or 1-800-MEDICARE.
Good to know
Frequently asked questions
Does the $2,100 cap include my monthly premium?
What happened to the donut hole?
I take one inexpensive generic. Do these changes matter for me?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.